Severe adverse reactions to dental local anaesthetics: prolonged mandibular and lingual nerve anaesthesia

Authors

  • PJ Sambrook,

    1. Oral and Maxillofacial Surgery Unit, The University of Adelaide, South Australia.
    2. RACDS representative, Editorial Advisory Panel, Australian Prescriber.
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  • AN Goss

    1. Oral and Maxillofacial Surgery Unit, The University of Adelaide, South Australia.
    2. Member, Dental Therapeutics Committee, Australian Dental Association Inc.
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Professor Alastair Goss
Oral and Maxillofacial Surgery Unit
Faculty of Health Sciences
The University of Adelaide
Adelaide SA 5005
Email: alastair.goss@adelaide.edu.au
Web: http://www.dentistry.adelaide.edu.au/o&mfs/0&mfs_index.html

Abstract

Background:  Prolonged anaesthesia may occur following dental local anaesthetic blocks. This paper reviews the possible mechanisms of injury. Direct injury to the nerve by the needle, although commonly thought to be the mechanism, is unlikely. It is much more likely that the injury is from neurotoxicity and/or interference with the vascularization of the nerve.

Methods:  Estimation of the frequency of injury was complicated by the fact that although local anaesthetics are prescription-only (S4) drugs, they are supplied without prescription by dental supply houses. Unlike all other S4 drugs, there is no statutory requirement to record supply. The pharmaceutical and supply houses relied on that and ‘commercial confidentiality’ to not supply information.

Results:  An informed estimate of 1 in 27 415 was made but this figure has wide confidence limits. Management of cases of prolonged anaesthesia following local anaesthetic injection is discussed.

Conclusions:  Patients who suffer this uncommon complication suffer considerable distress and feel injured, so care must be exhibited in their management. Specialist referral is recommended.

Ancillary